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Oncology / Transfusion medicine / Febrile neutropenia / Neutropenia / Thrombocytopenia / Platelet / Bleeding / Fever / Mucositis / Medicine / Biology / Blood


Attribution Key: Unrelated 1 The adverse event (toxicity) is not related to the investigational agent(s). Page 1 of 3 Unlikely 2 The adverse event (toxicity) is doubtfully related to the investigational agent(s). Revised
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Document Date: 2008-05-28 21:39:37


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IndustryTerm

Cancer Treatment / Cancer Therapy / /

MedicalCondition

Stomatitis/pharyngitis / fever / Yes No INFECTION/FEBRILE NEUTROPENIA Catheter-related infection / ARRHYTHMIA / Vomiting / PAIN / Event Category/Toxicity Grade *Attribution Yes No ALLERGY/IMMUNOLOGY Allergic reaction/hypersensitivity / oral/pharyngeal mucositis / Urticaria / microbiologically documented infection / Yes No CONSTITUTIONAL SYMPTOMS Fatigue / Diarrhea / Infection / Dysphagia / hives / esophagitis / Event Category/Toxicity Grade *Attribution Yes No DERMATOLOGY/SKIN Alopecia / Rash / neutropenia / Nausea / thrombocytopenia / Hypotension / Dehydration / /

Organization

Data Collection Form Division of Cancer Treatment and Diagnosis Cancer Therapy Evaluation Program Please Print / /

Technology

treating cancer / /

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